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76 Cards in this Set
- Front
- Back
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What % of body weight is TBW in
-males -females -infants |
Males 55%
Females 45% Infants 80% |
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How is TBW different in Obese?
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Less % of TBW - fat has little water
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What happens to ADH under GETA?
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It increases - so you retain more fluid
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What does fluid therapy in anesthesia START with?
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Preop assessment of fluid balance
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What labs might suggest dehydration?
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High Hb, BUN, Crt, and Urine sp grav
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What is Orthostatic hypotension?
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A decrease in Syst BP of >20 when going from supine to standing
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What does Ortho hypo indicate?
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Fluid deficit of 6-8% of TBW
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What VS compensates for orthostatic hypotension?
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HR - increases
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What are 2 things indicated by lack of HR increase in a patient with orthostatic hypotension?
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-Autonomic dysfunction
-Beta-blocker |
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What is the maintenance fluid requirment formula?
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4-2-1
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For what patients is the 4-2-1 rule especially important?
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Pediatrics
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In what instances are maintainance fluid requirements increased?
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-Fever
-Tracheotomy -Denuded surfaces |
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How do you calculate NPO deficit?
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# hrs NPO x hourly maintainance
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How is NPO deficit ADMINISTERED?
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Half over the first hour
25% over 2nd hr 25% over 3rd hr |
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What is the max hourly rate of infusion and why?
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30 cc/kg/hr
More can cause pulmonary edema |
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What if a patient has an ostomy?
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Add the total taken out to the NPO deficit
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What is third space loss?
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Transfer of extracellular fluid into interstitial space where it is nonfunctional
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How do you replace fluid loss from surgical trauma?
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Crystalloid - 3cc/cc lost
Blood/colloid - 1cc/cc |
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How do you replace ongoing fluid loss from other sites?
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1:1 with crystalloid
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What are 4 main types of IV fluids?
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-Crystalloid
-Colloid -Hypertonic solution -Blood products |
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What is Normal saline?
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Simply SALT - just NaCl
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What are 3 types of Balanced salt solutions?
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-LR
-Plasmalyte -Normosol |
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Why do we give lactated solutions?
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They cause less metabolic Acidosis
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When can't we give lactated solutions? Why?
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Transfusions - lactate is incompatible with blood
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What is D5W? What is in it? What is its osmolality?
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Hypotonic solution - nothing; osmolality is 253
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What is Normal Saline? Osm?
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0.9% NaCl - 308, isotonic
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What is LR? Osm?
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Isotonic, 273
Na/K, Ca, Cl, lactate |
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What is 3% Saline? Osm?
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HYPERtonic - 1027!!
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Why do we have to give Plasmalyte instead of LR if giving blood?
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Bc Plasmalyte has no CALCIUM - so it won't cause coag like LR would
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What are Colloids?
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Fluids with molecules large enough to prevent transfer across capillary membranes
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What happens when you give colloid?
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It STAYS in the space into which it was infused!
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What are colloids aka?
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Volume expanders
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3 examples of colloids:
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-Albumin
-Hetastarch -Dextran |
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What are hypertonic solutions?
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Fluids with more solute than normal saline/plasma
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What do hypertonic solutions do to the body?
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Pull fluid out of cells - can cause cellular dehydration
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What are the 5 ways that we evaluate fluid replacement clinically?
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-Urine output
-Vital signs - HR/BP -Physical exxam - skin/mucous memb -Invasive monitoring - CVP/PCWP -Lab tests - Hb/Hct |
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What should the urine output be?
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At least 1cc/kg/hr
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What % of all transfusions occur perioperatively?
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60%
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Who is responsible for perioperative transfusions?
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The anesthesiologist!
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What is DO2?
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Oxygen delivery - the amt of O2 delivered to the tissues
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What is DO2?
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Oxygen delivery - the amt of O2 delivered to the tissues
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What does DO2 equal?
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DO2 = CO x CaO2
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What is CaO2?
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Oxygen content of blood
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What does CaO2 equal?
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CaO2 = (Hbx1.34)Sao2 + PaO2x.003
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What does CO=?
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CO = HR x SVS
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So what does DO2 = ?
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DO2 = HRxSVxCaO2
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What Hb level can healthy patients vs compromised pts tolerate?
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Healthy = 7g/dl
Compromised = 10 g/dl |
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What does allowable blood loss depend on?
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Age
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What is the est blood vol in
-adults -children -neonates |
Adults - 70 ml/kg
Children - 75 ml/kg Neonates - 80 ml/kg |
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How do you calculate allowable bloodloss?
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TBV x (start hb - trigger hb)/start hb
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How much crystalloid do you give when replacing blood loss?
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3cc crystal per cc bloodloss
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What are the 2 most common blood types in caucasians?
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A and O
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What testing is done for blood for intraoperative transfusion?
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Type/screen
(not a crossmatch) |
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What is the diff between Major and Minor Crossmatch?
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Major - Donor RBC/recip Plasma
Minor - Donor plasma/recip RBCs |
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What is whole blood and what is an advantage of it?
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RBCs + Clotting factors
Less donor exposure |
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What are the disadvantages of whole blood?
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-Decr Clotting fx activity w/ storage
-Hct only 40% |
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Why is component therapy better than Whole blood?
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Allows for longer storage
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What is the Hct of PRBCs?
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70-80%
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How much does 1 unit of PRBCs raise an adult's hemoglobin?
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1 g/dl
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What can you NOT administer w/ PRBCs?
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NOT LR - must give NS or you might cause a clot to form
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How much does 1 unit of platelets increase the plt count?
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5-10,000 cells
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What is the perioperative Plt transfusion trigger?
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Plt count of 50-100,000 cells
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When does FFP have to be frozen?
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W/in 6 hrs of collection
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What does FFP contain?
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Coag factors
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Which coag factor decays fastest?
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Fx VII
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What is FFP indicated for?
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Treating isolated factor deficiencies
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What are 3 risks of FFP?
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-Viral transmission
-Allergy -Hypocalcemia if rapid transfusion |
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What is the MC complication of transfusion therapy and how is it managed?
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Febrile rxn - slow the infusion and give antipyretics
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What can you do for urticarial allergic rxn to transfusion?
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Give benadryl and continue
D/c if severe |
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If you see free Hb in plasma and/or urine, what do you suspect?
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Hemolytic transfusion rxn
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What is the most common virus transmitted thru transfusion?
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CMV
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What blood must be given for immunocompromised patients?
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CMV-negative
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Why does too rapid of infusion of FFP cause life threatening hypocalcemia?
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Bc the citrate in it binds to calcium
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How much of a patient's own blood can be donated prior to elective surgery for autologous transfusion?
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1 unit q4 days up to 3 units
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How many hrs prior to the surgery does the last donation have to be done?
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72 hrs before
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For what pts is autologous transfusion not good?
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Compromised
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